QUESTION

I work in Central Africa republic.I was recently diagnosed with malaria (p.falciparum) after a blood test—my 4th attack in 15 months and given Co-Arinate. Two days after completing my dose I went for a 2nd blood test and the trophozoite count was 720/mm3.

The doctor prescribed co-artem and said if I don’t get better he shall transfuse quinine. Whats your comment on the treatment? Do these malaria medications/attacks have a long term effect on ones liver? What prophylaxis should I consider to prevent future attacks.

ANSWER

I will forward your question on to one of the medical professional who advises our website. However, normal procedure after treatment failure or incomplete treatment with one type of anti-malarial medication would be to try another type of medication first; Co-Arinate might not have been an ideal first choice given that many types of malaria around the world are showing signs of resistance to pyrimethamine, the combination drug in Co-Arinate.

Co-Artem would be a better first choice drug, given that there is no convincing evidence for resistance to its combination compound, lumefantrine. Quinine could be a potential next step though I would imagine Co-Artem will be successful—make sure the drugs have not expired and are in their original packaging, as counterfeit medication is a problem in many parts of the world.

Regarding prevention, a key method is to sleep under a long-lasting insecticide treated bednet; make sure it is re-dipped in insecticide every year or so to maintain its efficacy. The mosquitoes which transmit malaria tend to feed at night, and so protecting yourself and your home during the evening, night and early morning is crucial. Maintaining good screens on all windows and doors can be a very effective way of preventing mosquitoes from entering, and in many parts of the world, people spray inside with insecticides to reduce the number of mosquitoes yet further. Wearing long-sleeved clothing at night and in the evenings can also prevent bites.

More broadly speaking, you can try to make sure that stagnant water sources, such as empty containers or barrels, are removed, as mosquitoes require still water to breed. Reducing the presence of stagnant water will therefore reduce mosquito numbers; treating standing water with larvacides or adding fish that eat mosquito larvae can also help.